Air Evac Lifeteam

We all know in a medical emergency, seconds count. But what happens in rural Texas when you are miles from the nearest hospital and you need immediate medical attention? This was one of the questions your Board of Directors was concerned about. As a result, CECA has teamed up with Air Evac Lifeteam, a part of the AirMedCare Network, to present you with one more option to make life safer and easier.

Air Evac Lifeteam is an air ambulance service provider to rural communities in the central U.S., founded in 1985 with the goal of providing rural markets access to better medical care. Today, Air Evac Lifeteam has grown to be the largest independently owned and operated membership supported air ambulance service in the U.S. operating more than 100 bases across 15 states. Now that they are a part of the AirMedCare Network, you will have coverage across 32 states with over 240 aircraft locations!

Now, because CECA and AirMedCare Network have partnered up, you too can become a member. The process is simple. Simply fill out the application below. In turn, CECA will bill you a $5.00 per month membership to cover your entire family.

Although you do not have to be a member to use the service, membership offers significant benefits:

Members who are flown for a life-or-limb threatening emergency will have no out-of-pocket expense in connection with the flight.

Peace of Mind so you can focus on your recovery.

Support your community! AMCN has over 2.4 million members. Be a part of something BIG!

You will receive membership identification cards for your wallet, and identification stickers for your home and automobiles, so the EMS and first responders know you are a member!

Step 1: Member Contact Information

Full Legal Name *

Physical Address *

Mailing Address (Street or PO Box) *

City, State, Zip *

County *

Home Phone

Cell Phone

Email

Date of Birth *

Do you live in the city limits? *

Yes

No

Step 2: List Other Persons In Household and Date of Birth

Full Name and Date of Birth

Step 3: Membership and Payment Options

Monthly Membership: $5 per Household

Authorization *

I authorize CECA to add $5 per month to my bill and to dispurse the money as payment for my AirMedCare Network Membership. I understand this authorization will stay in effect as long as I am a member of CECA, or until I submit a written cancellation.

CECA Account Number (if known)

Terms and Conditions *

By signing this authorization I agree to the terms and conditions stated herein and acknowledge that I authorized to have the additional $5 AMCN fees added to my CECA bill. I also understand that I will communicate directly with AirMedCare Network for Membership Member Service.

Terms and Conditions:
AirMedCare Network is an alliance of affiliated air ambulance providers* (each a “Company”). An AirMedCare Network membership automatically enrolls you as a member in each Company’s membership program. Membership ensures the patient will have no out-of-pocket flight expenses if flown by a Company by providing prepaid protection against a Company’s air ambulance costs that are not covered by a member’s insurance or other benefits or third party responsibility, subject to the following terms and conditions: 1. Patient transport will be to the closest appropriate medical facility for medical conditions that are deemed by AMCN Provider attending medical professionals to be life- or limb-threatening, or that could lead to permanent disability, and which require emergency air ambulance transport. A patient’s medical condition, not membership status, will dictate whether or not air transportation is appropriate and required. Under all circumstances, an AMCN Provider retains the sole right and responsibility to determine whether or not a patient is flown. 2. AMCN Provider air ambulance services may not be available when requested due to factors beyond its control, such as use of the appropriate aircraft by another patient or other circumstances governed by operational requirements or restrictions including, but not limited to, equipment manufacturer limitations, governmental regulations, maintenance requirements, patient condition, age or size, or weather conditions. FAA restrictions prohibit most AMCN Provider aircraft from flying in inclement weather conditions. The primary determinant of whether to accept a flight is always the safety of the patient and medical flight crews. Emergent ground ambulance transport of a member by an AMCN Provider will be covered under the same terms and conditions. 3. Members who have insurance or other benefits, or third party responsibility claims, that cover the cost of ambulance services are financially liable for the cost of AMCN Provider services up to the limit of any such available coverage. In return for payment of the membership fee, the AMCN Provider will consider its air ambulance costs that are not covered by any insurance, benefits or third party responsibility available to the member to have been fully prepaid. The AMCN Provider reserves the right to bill directly any appropriate insurance, benefits provider or third party for services rendered, and members authorize their insurers, benefits providers and responsible third parties to pay any covered amounts directly to the AMCN Provider. Members agree to remit to the AMCN Provider any payment received from insurance or benefit providers or any third party for air medical services provided by the AMCN Provider, not to exceed regular charges. Neither the Company nor AirMedCare Network is an insurance company. Membership is not an insurance policy and cannot be considered as a secondary insurance coverage or a supplement to any insurance coverage. Neither the Company nor AirMedCare Network will be responsible for payment for services provided by another ambulance service. 4. Membership starts 15 days after the Company receives a complete application with full payment; however, the waiting period will be waived for unforeseen events occurring during such time. Members must be natural persons. Memberships are non-refundable and non-transferable. 5. Some state laws prohibit Medicaid beneficiaries from being offered membership or being accepted into membership programs. By applying, members certify to the Company that they are not Medicaid beneficiaries. 6. These terms and conditions supersede all previous terms and conditions between a member and the Company or AirMedCare Network, including any other writings, or verbal representations, relating to the terms and conditions of membership. *Air Evac EMS, Inc. / EagleMed LLC / Med-Trans Corporation / REACH Air Medical Services, LLC — These terms and conditions apply to all AirMedCare Network participating provider membership programs, regardless of which participating provider transports you.

Please type your First and Last Name *

Acknowledgement *

I understand that checking this box constitutes a legal signature confirming that I am the applicant listed on the application.

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